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Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children

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Abstract

Background

Laparoscopic inguinal hernia repair is one of the procedures most commonly performed by paediatric surgeons. Current research on the learning curve for laparoscopic hernia repair in children is scarce. This study aims to evaluate the clinical outcome and learning curve of laparoscopic intra-corporeal inguinal hernia repair in children.

Methods

A retrospective single-centre analysis of all paediatric patients who underwent laparoscopic intra-corporeal inguinal hernia repair between 2010 and 2019 was performed. The clinical outcomes were analysed. The data on the achievement of the learning curve by surgical trainees were evaluated with the CUSUM technique, focusing on operative time.

Results

There were 719 patients with laparoscopic intra-corporeal inguinal hernia repair (comprising 1051 sides) performed during the study period. The overall ipsilateral recurrence rate was 1.8% without other complications detected. CUSUM analysis showed that there were 3 phases of training, for which the trainees underwent initial learning phase (Phase 1) for the first 7 cases. After mastering of the skills and extrapolating the skills to male patients with smaller body size (Phase 2), they then achieved performance comparable to that of the senior surgeons after 18 procedures (Phase 3).

Conclusions

18 procedures seem to be the number required to reach the learning curve plateau in terms of operative time by surgical trainees. The clinical outcomes show that laparoscopic intra-corporeal inguinal hernia repair is a safe and transferrable technique, even in the hands of trainees, with adequate supervision and careful case selection. It also provides skill acquisition for minimally invasive surgery.

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Authors and Affiliations

  1. Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People’s Republic of China

    Adrian Chi Heng Fung, Ivy Hau Yee Chan & Kenneth Kak Yuen Wong

  2. Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, People’s Republic of China

    Ivy Hau Yee Chan

Authors
  1. Adrian Chi Heng Fung
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  2. Ivy Hau Yee Chan
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  3. Kenneth Kak Yuen Wong
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Correspondence to Ivy Hau Yee Chan.

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Drs. Adrian Chi Heng Fung, Ivy Hau Yee Chan, and Prof. Kenneth Kak Yuen Wong have no conflicts of interest or financial ties to disclose.

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The project does not include any interaction or intervention with human subjects or include any access to identifiable private information therefore no IRB approval was deemed necessary.

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Fung, A.C.H., Chan, I.H.Y. & Wong, K.K.Y. Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children. Surg Endosc 37, 434–442 (2023). https://doi.org/10.1007/s00464-022-09530-1

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  • DOI: https://doi.org/10.1007/s00464-022-09530-1

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